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ESSENTIA HEALTH SPECIALTY PHARMACY
CAH241340-00 NORTHERN PINES MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTHERN PINES MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241340-00
Entity Address
5211 HIGHWAY 110
AURORA, MN 55705
Medicare Provider Number
241340
Participating Start Date
10/1/2012
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
ESSENTIA HEALTH SPECIALTY PHARMACY
Pharmacy Address
204 BELKNAP ST STE 200
SUPERIOR, WI 54880-2905
Pharmacy Comments
Contract Details
Approval Date
10/14/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laura Ackman, President
(218) 229-2211 Ext: 4222
Contract Pharmacy Representative
Essentia Health
Kenzie Hohman, Senior Director of Ambulatory Pharmacy
(715) 817-7171
Signed By Date
10/14/2015
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